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Biomedical subjects

K K Tremper

Publications and source records attributed to K K Tremper.

At least 91 records · Page 5Linked to original sources
PubMed1984

Hemodynamic profile of adverse clinical reactions to Fluosol-DA 20%.

Hemodynamic changes of 2 patients to a 0.5-ml test-dose infusion of Fluosol-DA 20% are presented. The first patient had the following symptoms and signs approximately 2 min after receiving the test dose: normotensive bradycardia of 30 beat/min, a 35% drop in cardiac output, a 50% increase in systemic vascular resistance, and a 100% increase in pulmonary artery systolic and diastolic pressures. The patient complained of shortness of breath and diffuse pressure pain of the chest. All the signs and symptoms gradually resolved without treatment over the following 3 min. The second patient complained of mild, vague chest and abdominal pressure 2 min after the test dose. The only associated hemodynamic change was a slight increase in pulmonary artery systolic pressure. A 74% drop in the neutrophil count returned to the pretest value in 10 min. In contrast to anaphylactic or anaphylactoid-type reactions, these patients did not have urticaria and had an increase in systemic vascular resistance. Their reactions were reminiscent of those occurring during systemic complement activation. The possible mechanisms and prevention of these reactions are discussed.

Adult↗
PubMed1984

U.S. clinical studies of the treatment of anemia with fluosol-DA 20%.

This article describes the progress of clinical studies of the perfluorochemical (PFC) emulsion Fluosol-DA 20% in the United States. To date, two studies have been completed and one is in progress. All three studies have been restricted to the treatment of acute anemia in patients who refused blood transfusions on religious grounds, i.e., Jehovah's Witnesses. The first protocol, referred to as the "Humanitarian Protocol" (no. 79006), was initiated in November 1979. Jehovah's Witness patients who were considered to have a lethal degree of anemia were treated with Fluosol to supplement oxygen transport. Collection of specific data was not mandated in this protocol. Six patients were treated under this protocol until it was replaced by the "Medical Use Protocol" (no. 79007). In this second study, hemodynamic and oxygen transport data were collected while patients breathed room air and 100% inspired oxygen before and after a Fluosol infusion. Seven patients were treated under this protocol and it was concluded that the PFC was transporting the expected amount of oxygen based on its known oxygen solubility. This increased oxygen transport by the PFC resulted in increased oxygen consumption and arterial and mixed venous blood oxygenation. Two of the seven patients had adverse reactions to a 0.5-ml test dose of Fluosol, manifested by an increase in pulmonary artery systolic pressure. The third and current anemia protocol as of this writing is a randomized controlled study with data collection similar to the Medical Use Protocol.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia↗
PubMed1984

Transcutaneous monitoring of oxygen tension during one-lung anesthesia.

Twenty adult patients were monitored with a transcutaneous oxygen tension sensor during one-lung ventilation. Anesthesia was maintained with enflurane-oxygen or isoflurane-oxygen. The transcutaneous oxygen tension values accurately followed the trend of arterial oxygen tension (r = 0.94, n = 96, transcutaneous oxygen tension = 4.8 + 0.78 X arterial oxygen tension). The transcutaneous oxygen tension values averaged 80% of the arterial oxygen tension values (transcutaneous oxygen tension index = transcutaneous oxygen tension/arterial oxygen tension = 0.80 +/- 0.18) (mean +/- standard deviation). When one-lung ventilation was initiated, there was a progressive drop in transcutaneous oxygen tension which reached a minimum of 19 +/- 10 minutes. The mean of the minimum transcutaneous oxygen tension and arterial oxygen tension values was 66 +/- 44 torr and 83 +/- 43 respectively. This resulted in a mean alveolar-arterial oxygen gradient of 515 +/- 152 torr during one-lung ventilation. In eight patients, the arterial oxygen tension fell below 60 torr, 45 +/- 9 torr. When two-lung ventilation was resumed, the transcutaneous oxygen tension and arterial oxygen tension values promptly rose to mean values of 342 +/- 121 torr and 411 +/- 103 torr, respectively in 9 +/- 3 minutes. The transcutaneous oxygen tension monitor provided a continuous assessment of the patient's oxygenation, gave early warning of potentially hazardous hypoxia, and permitted nearly real-time assessment of the efficacy of corrective therapies.

Adult↗
PubMed1983

Transcutaneous oxygen monitoring of emergency department patients.

Transcutaneous oxygen sensor values reflect peripheral oxygen tensions. During shock and resuscitation, transcutaneous oxygen sensor values depend on peripheral blood flow, and, therefore, reflect cardiac output and oxygen delivery. Transcutaneous oxygen sensor monitoring, therefore, should be quite useful when caring for acutely ill patients; data from 20 surgical emergency department patients support this hypothesis. A normal initial transcutaneous oxygen sensor value of greater than 60 torr, as found in 11 of our patients, implied relatively normal oxygenation and circulation. A low initial transcutaneous oxygen sensor value of less than 60 torr implied deficits of either arterial oxygenation or of perfusion (these can be distinguished by an arterial blood gas determination). In addition, transcutaneous oxygen sensor was useful for continuous monitoring during resuscitation. Successful correction of hypoxia and perfusion deficits results in increased transcutaneous oxygen sensor values. Failure of the transcutaneous oxygen sensor value to increase during resuscitation implies ongoing deficits of tissue oxygenation.

Emergency Service, Hospital↗
PubMed1983

Continuous transcutaneous oxygen monitoring during an intraoperative cardiac arrest.

A transcutaneous oxygen sensor was used continuously during surgical management of a ruptured abdominal aortic aneurysm. Closed chest compression initiated for intraoperative cardiac arrest gave an inadequate cardiac output on the basis of falling PtcO2 despite transmitted femoral pulses and an excellent PaO2. This discordance provided a rationale for open cardiac massage, which increased the cardiac output and tissue perfusion (PtcO2) needed for successful resuscitation. The PtcO2 sensor provides immediate, non-invasive, and continuous information regarding tissue oxygenation. It reflects the PaO2 in hemodynamically stable patients as well as providing a sensitive indicator for inadequate cardiac output during shock. In patients undergoing cardiopulmonary resuscitation, a falling PtcO2 with an acceptable PaO2 indicates poor tissue perfusion and, in select circumstances, may warrant open cardiac massage.

Blood Pressure↗
PubMed1982

The preoperative treatment of severely anemic patients with a perfluorochemical oxygen-transport fluid, Fluosol-DA.

We gave a perfluorochemical oxygen-transport fluid and plasma expander, Fluosol-DA, to seven severely anemic patients before surgery to determine its effectiveness in supplementing oxygen transport. The dose of Fluosol in the five patients completing the study was 20 ml per kilogram of body weight. When the patients breathed low levels of supplemental oxygen (mean partial pressure of arterial oxygen +/- S.D., 101 +/- 25 torr), the perfluorochemical carried a small amount of oxygen, but when they received pure oxygen (arterial oxygen pressure, 361 +/- 65 torr) it carried approximately 0.8 per cent of oxygen (by volume). This increase accounted for 7 +/- 3 per cent of the patients' arterial oxygen content and 24 +/- 7 per cent of their oxygen consumption. The cardiac index and left ventricular stroke-work index decreased, whereas the oxygen delivery increased, although these changes were not statistically significant. Significant changes included a 22 per cent increase in oxygen consumption, a 59 per cent increase in mixed venous oxygen tension, and an increase in mixed venous hemoglobin saturation to 90 +/- 6 per cent. We conclude that at ambient oxygen tensions fluosol acts primarily as a volume expander, whereas at higher tensions (greater than 300 torr) it contributes substantially to the oxygen-delivery system.

Adult↗
PubMed1981

Use of transcutaneous oxygen sensors to titrate PEEP.

The relationship of transcutaneous oxygen tension (PtcO2) to arterial oxygen tension (PaO2), pulmonary shunt (Qsp/Qt), mixed venous oxygen tension (PVO2), and O2 delivery was determined in patients with respiratory failure in order to explore the possible usefulness of PtcO2 to titrate the level of positive end expiratory pressure (PEEP). Transcutaneous oxygen sensors were applied to the chest of surgical ICU adult patients who were in acute postoperative respiratory failure. The patients had mechanical ventilation with volume ventilators and an intermittent mandatory ventilation (IMV) rate, which allowed normal pH and arterial CO2 tension ventilation (PacO2). Swan-Ganz and arterial catheters were inserted. The blood volume was measured by iodinated I-125-serum albumin and brought into the normal range, before the study began, with appropriate volume therapy. Serial cardiorespiratory data were taken before and after PEEP was increased from zero to 20 cm H2O, in 5 cm increments. PtcO2 correlated well with PaO2 and PV-O2; it was inversely correlated with Qsp/Qt. PtcO2 correlated with O2 delivery in only seven severely ill patients mean alveolar-arterial oxygen tension difference [A-aDO2] was 380 mmHg and the pulmonary shunt was 37%). For the eight other patients, variations in the greatly elevated cardiac output associated with hypoxemia led to poor correlations between PtcO2 and O2 delivery. There was no significant depression of cardiac output in any of the studies. We conclude that the continuous noninvasive nature of PtcO2 monitoring greatly increased the safety and simplicity of PEEP optimization and respiratory management of adult patients with respiratory failure.

Blood Pressure↗
PubMed1981

Transcutaneous oxygen monitoring of critically ill adults, with and without low flow shock.

One hundred and six critically ill adult patients were monitored continuously with a transcutaneous oxygen sensor (PtcO2); they also were intermittently monitored with conventional invasive hemodynamic and oxygen transport variables. A total of 1073 data sets were taken on 41 patients in the ICU and 65 patients in the operating room. The patients were divided into three groups by cardiac index (CI): relatively normal flow, CI greater than 2.2 L/min x M2; moderate low flow shock, 2.2 greater than CI greater than 1.5 L/min x M2; and severe low flow shock, CI less than 1.5 L/min x M2 x PtcO2 and arterial oxygen tension (PaO2) were compared in two ways: first by linear regression and second by a more simple clinical guide by indexing each transcutaneous value by its respective arterial value (PtcO2 index = PtcO2/PaO2). For 934 data sets taken on 92 patients not in shock, there was a correlation coefficient (r) of 0.89 and a PtcO2 index 0.79 +/- 0.12 (SD). In 5 patients with moderate shock, the r was 0.78 and the PtcO2 index was 0.48 +/- 0.07. In 9 patients with severe shock, there was no correlation between PtcO2 and PaO2 and the PtcO2 index was 0.12 +/- 0.12. In all cases of severe shock, the PtcO2 value responded quickly to changes in blood flow with an approximate 1 min response time (95%). The patients not in shock responded to changes in inspired oxygen concentration (FIO2) with changes in PaO2 and PtcO2 values; the 95% response time was approximately 2 min. The authors conclude that the normal value for PtcO2 for adult surgical patients who are hemodynamically stable is 79 +/- 12% of the PaO2 and that PtcO2 values were reliable, continuous, noninvasive trend monitors of PaO2 in these patients. During circulatory problems when PtcO2 values were compared to PaO2 values (PtcO2 index), the changes reflected trends in the severity of low flow shock.

Adult↗
PubMed1981

Emergency PaO2 estimates in one minute with a transcutaneous oxygen sensor.

Blood was applied directly to the electrode surface of a transcutaneous oxygen sensor (PtcO2) and the oxygen tension value obtained was compared to oxygen tension value from a conventional blood gas machine. Three hundred and seventeen blood samples were analyzed at four PtcO2 electrode temperatures: 37, 40, 42, and 45 degrees C. A linear regression of PO2 vs. PtcO2 blood drop (PbdO2) produced correlation coefficients (r) from 0.99 to 0.93 and standard errors from 3.2 to 4.7 torr at these temperatures. The mean time for stabilization was 51 sec. The PO2 ranged from 4--150 torr. The authors conclude that an accurate PO2 of blood can be obtained within 1 min by placing a drop of blood on the surface of a PtcO2 electrode.

Blood Gas Analysis↗
PubMed1981

Transcutaneous PCO2 monitoring on adult patients in the ICU and the operating room.

Studies were performed on 44 patients who were monitored continuously with transcutaneous carbon dioxide (PtcCO2) sensors. The patients were monitored intermittently with arterial and mixed venous blood gases and full hemodynamic and oxygen transport data. Twenty of the studies were performed intraoperatively. A total of 411 data sets revealed a correlation coefficient, r, between arterial and transcutaneous PCO2 of 0.80 when the patients were not in low flow shock, i.e., cardiac index (CI) greater than 1.5 L/min x M2. On the basis of these data, the authors have found the normal arterial-transcutaneous carbon dioxide gradient, delta CO2, (delta CO2 = PtcCO2 -- PaCO2) to be 23 +/- 11 torr. The PtcCO2 monitor was found to be a valuable trend monitor of arterial CO2 tensions of adults during adequate cardiac function in the ICU and the operating room. Twenty-four data sets were collected while 3 patients were monitored during severe shock (CI less than 1.5 L/min x M2). PtcCO2 trended inversely with changes in CI during shock and did not follow PaCO2 (r = --0.85). During shock, delta CO2 = 61 %/- 25 torr. The severity of shock could be roughly determined by comparing the PtcCO2 values with arterial CO2 tensions.

Adult↗
PubMed1980

Continuous transcutaneous oxygen monitoring during respiratory failure, cardiac decompensation, cardiac arrest, and CPR. Transcutaneous oxygen monitoring during arrest and CPR.

The transcutaneous oxygen sensor (PtcO2), which has been used to predict PaO2 in neonates, recently has been shown to follow changes in oxygen delivery, rather than PaO2 during shock and hypoxia in dogs. Six preterminal patients were continuously monitored with PtcO2 and monitored hemodynamically at frequent intervals during cardiac decompensation, arrest, and cardiopulmonary resuscitation (CPR). The weighted mean correlation coefficients between PtcO2 and O2 delivery as well as between PtcO2 and cardiac output were 0.94 and 0.96, respectively. Five patients died of severe ARDS and 1 patient died intraoperatively of hemorrhagic shock. Four patients were monitored 1-7 days before shock occurred. The correlation between PtcO2 and PaO2 was 0.91 during periods of normal cardiac output in the preterminal period. During cardiac decompensation, the cardiac output, PtcO2, and mixed venous oxygen tension (PcO2) of 25 torr was reached, the PtcO2 fell below the PvO2. This also corresponded to a decrease in VO2. The mean VO2 was 142 +/- 24 ml/min x M2 for PtcO2 values > torr, and 75 +/- 15 ml/min x M2 for PtcO2 < 25 torr (p < 0.01). A PtcO2 of > 40 torr corresponded to normal cardiac index, O2 delivery, VO2, PvO2, and arterial pH (pHa) while a PtcO2, of < 25 torr corresponded to large reductions of these variables. A PtcO2 of < 25 torr preceded cardiac arrest by 43 +/- 28 min.

Cardiac Output↗
PubMed1980

Effect of hypercarbia and shock on transcutaneous carbon dioxide at different electrode temperatures.

Transcutaneous CO2 tension (PtcCO2) was measured with heated and nonheated transcutaneous carbon dioxide electrode sensors during hypercarbia and standardized hypovolemic shock in anesthetized dogs. The 95% response times of the PtcCO2 electrode, measured during step increases in FICO2 at four electrode temperatures: 37, 39, 41, and 44 degrees C, were 15, 7.5, 5, and 3.5 min, respectively. During experiments with normal cardiac output, the PtcCO2 correlated well with PaCO2 (r = 0.96). Three PtcCO2 electrode temperatures were tested for response to hypovolemic shock. Data from all PtcCO2 electrodes failed to correlate with PaCO2 during shock. PtcCO2 values rose as cardiac output decreased; there was a good negative correlation (r = -0.95). The 37 and 42 degrees C electrodes were affected by shock at cardiac index values below 2 L/min.M2; but the 44 degrees C probe was not affected until a cardiac index of 1.5 L/min.M2 was reached. Values from the 44 degrees C electrode rapidly returned to preshock values after fluid resuscitation. The response to resuscitation lagged in the 37 and 42 degrees C electrodes and did not return the preshock values until the cardiac index had been normalized for more than 15 min. It was concluded that a PtcCO2 electrode heated to 44 degrees C would be more useful in adult patients because of its faster response to hypercarbia, shock, and resuscitaton. The PtcCO2 values are higher than the corresponding PaCO2 values but they correlate well until the cardiac index (CI) falls below 1.5 L/min.M2; then PtcCO2 values have a strong negative correlation with the corresponding CI values.

Animals↗
PubMed1980

Hemodynamic and oxygen transport effects of a perfluorochemical blood substitute, fluosol-DA (20%).

Cardiorespiratory measurements were made in a severely anemic patient (hemoglobin concentration of 3.5 g/dl) who was preoperatively given the perfluorochemical blood substitute (Fluosol-DA, 20%). Hemodynamic and oxygen transport variables were monitored, including arterial and mixed venous oxygen content (CaO2 and CVO2) before, during, and after infusion of 1000 ml of Fluosol as well as throughout the intraoperative period. Blood samples revealed a maximum of 2.7% of the perfluorochemical. The CaO2 increased 37% above the CaO2 calculated without Fluosol; i.e., 5.8 +/- 0.1 to 8.1 +/- 0.6 ml/dl, p < 0.01. The cardiac index (CI) decreased from 7.2 +/- 0.2 to 5.9 +/- 0.8 L/min . M2 and the left ventricular stroke work decreased from 67 +/- 6 to 58 +/- 13 g . M/M2, while the oxygen delivery increased, and the total body oxygen consumption (VO2) remained essentially unchanged.l Intraoperatively, 27% of the O2 delivery and 51% of the VO2 were transported by Fluosol. No adverse effects of the fluosol were noted.

Adult↗